Mental & behavioral health
Books and taxes for TMS clinics.
An insurance authorization that finally clears after six weeks, a client's thirty-six session course billed daily, a technician's hourly pay, and the loan payment on your TMS system. Gus sorts all of it, an accountant checks every transaction, and you get one number a month.
- From $197 a month
- An accountant on every transaction
- Cancel whenever
January came in at $13,000. A client's authorization finally cleared after six weeks of waiting, so his back-billed sessions all landed in one deposit.
- Insurance batch, back-billedInsurance treatment billing
- Private pay treatment coursePrivate pay treatment
- TMS technician payrollTechnician wages
- TMS system loan paymentEquipment financing
- Treatment coil replacementEquipment maintenance
Why your books are different
A TMS clinic's books go wrong around authorizations and daily sessions.
A generalist sees a deposit and an equipment loan payment. Your clinic runs a course of daily sessions over several weeks, waits on insurance authorizations that can take a month or more to clear, and carries a real loan on expensive treatment equipment. When the books flatten all of that, cash flow looks unpredictable when it is actually just a lag.
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1
Authorization delays make revenue look erratic
A course of thirty-six daily sessions cannot start billing until insurance approves it, and approval can take weeks, so a client who started treatment in one month might not generate a deposit until the next, making steady clinical work look like a slow patch.
What we doBooks insurance deposits when they land and keeps a note on which client's back-billed sessions they cover, so a lagging authorization does not read as a slow month. -
2
The TMS system's loan payment gets treated like rent
A treatment system can cost tens of thousands of dollars, and the monthly loan payment on it often gets filed as a flat operating expense instead of what it actually is: financing on a major piece of equipment with its own depreciation treatment.
What we doKeeps equipment financing in its own line, separate from general operating costs, and flags the purchase for the accountant's depreciation decision. -
3
A course of daily sessions gets billed as one lump instead of tracked daily
Thirty-six sessions delivered one weekday at a time can get billed and recorded inconsistently, which makes it hard to see how many active treatment courses are actually running at once.
What we doBooks treatment revenue as sessions are delivered and billed, so the clinic's active course load stays visible. -
4
Technician pay does not track with chair utilization
A TMS technician is often paid for scheduled hours regardless of how many sessions the chair actually runs that day, so a light day can look like wasted labor without context.
What we doKeeps technician wages in their own line against treatment revenue, so chair utilization and labor cost stay visible together.
Your categories
The categories Gus keeps for a TMS clinic.
Set up once for how the clinic gets paid and what it spends. Nobody hand-sorts a category. Gus does, and an accountant checks it.
Money in
- Insurance treatment billingDaily session billing to insurance for an approved course of treatment.
- Private pay treatmentClients paying directly for a course of sessions.
- Consultation and mapping feesInitial evaluation and motor threshold mapping, billed apart from daily sessions.
- Maintenance session revenueFollow-up sessions for clients returning after an initial course.
Money out
- Technician wagesPay for the TMS technician running daily treatment sessions.
- Equipment financingLoan or lease payments on the TMS system.
- Equipment maintenanceCoil replacement and service costs for the treatment system.
- Facility costsTreatment room rent, utilities, and maintenance.
- Malpractice insuranceCoverage for the prescribing physician and clinical staff.
- Billing and clearinghouseFees paid to submit and track insurance authorizations and claims.
What we watch for you
- Authorization lag
Weeks between a course starting and insurance approval, so a slow deposit does not read as a slow clinic.
- Active course load
How many clients are mid-course at once, so chair scheduling and revenue expectations line up.
- Cost per session
Equipment financing and maintenance against sessions delivered, so pricing reflects real cost.
- The set-aside
What the clinic will owe, tracked every month, so April is a number already known.
Ask Gus
Things TMS clinic owners ask Gus.
Text him like you would text anybody. He answers in plain English, and when a question is above his pay grade, an accountant looks and gets back to you.
No. I book it as the back-billed sessions it actually is and keep a note on the client, so it reads as a delayed payment, not a sudden windfall.
I keep that payment in its own line so you can see it clearly against your treatment revenue. Whether the math still works is worth a real look with the accountant using your full year.
I can show you billing activity by client if you share your session schedule alongside your bank statements. That gives a clearer picture than the deposits alone.
The tax side
The tax side of a TMS clinic.
Most of what goes wrong here is equipment and timing: a major piece of financed equipment mislabeled as overhead, and authorization delays mistaken for a bad month.
What your return has to get right
Your accountant signs it, so it gets done right the first time.
- Equipment depreciationA TMS system can usually be written off using Section 179 or bonus depreciation, with 100 percent bonus depreciation available for property acquired after January 19, 2025, up to the $2,560,000 Section 179 limit.
- Worker classification for techniciansA TMS technician who works your schedule and clinic protocols is almost always an employee, not a contractor.
- Interest on equipment financingInterest paid on a loan for the TMS system is generally deductible as a business expense, separate from the principal payment itself.
- The pass-through deductionClinic profit can often get up to a 20 percent deduction before tax, though the benefit tends to shrink for a personal-service medical practice once income climbs high enough.
Deductions TMS clinics miss
Your bookkeeper knows what to look for in your statements. You never have to.
- TMS system loan interest
- Coil and equipment maintenance
- Malpractice insurance premium
- State medical license renewal
- Technician training and certification
- Treatment room rent
- Billing and clearinghouse fees
- Client mapping and evaluation supplies
- Background check fees for new hires
- Business insurance beyond malpractice
- Continuing medical education
- Professional association dues
General information about 2026 federal rules, not advice for your business. Your accountant looks at your actual numbers before anything gets filed.
All year, not just April
A TMS clinic's year, kept every month.
Authorization delays and course starts can make monthly revenue uneven even when demand is steady. Gus keeps the clinic ahead of both the numbers and the tax deadlines. Every month in between, your bookkeeper closes the books and speaks up the moment something looks off.
- January
Plan the year
Last year's return gets started, and the monthly set-aside is planned around typical authorization delays.
- April
Filed. Done.
The business return is filed and signed. No surprise bill, because the set-aside has been running since January.
- July
Halfway check
Where the clinic stands, what it will owe, and whether course volume this year changed the number.
- October
Before year-end
Gus looks at whether a second treatment chair or other equipment purchase makes sense before December.
What you get
What you pay depends on what your business needs, and it does not move after that, busy season or slow. No hourly bills, no surprise invoices, no setup fee.
Book a call- Monthly bookkeeping
Every transaction sorted into categories set up for TMS clinics. You never categorize a thing.
- An accountant checks every transaction
Real review, every month, before your books close. Not a spot check.
- Your business tax return, filed
Prepared, reviewed, and signed by that same accountant every year.
- The monthly number
What you made, what you spent, what to set aside for taxes.
- Your own bookkeeper
A real person assigned to your business, in the app whenever you need them. No hold music.
- On your books all year
Every month, not just in April. Your team speaks up whenever something is worth your attention.
- Cancel any time
No contract. No cancellation call. Your books are yours.
Straight answers
Questions TMS clinic owners ask first.
How does Gus handle a big back-billed insurance deposit after a long authorization delay?
He books it against the sessions it actually covers and notes the client and the delay, so it reads as a catch-up payment rather than a surprise windfall.
Do you track which of our clients are mid-course right now?
Gus works from your bank and billing deposits. If you share your treatment schedule alongside that, he can show billing activity by client to build a clearer picture.
How does the loan on our TMS system get handled in the books?
The loan payment is kept in its own line, separate from routine expenses, and the equipment itself gets flagged for the accountant's call on depreciation.
Our technician is paid hourly regardless of how full the schedule is. Does that matter for the books?
It is booked as a wage cost either way, but Gus keeps it against treatment revenue so you can see chair utilization and labor cost together.
We are considering a second treatment chair. What should we know before buying?
Gus can show you what your current equipment costs and generates so the decision is based on real numbers, and flags the purchase for the accountant's depreciation guidance once you are ready.
Our books have never separated equipment financing from general expenses. Can that be fixed?
Yes. Hand over your loan statements and Gus will pull the financing payments out of past months, then keep them in their own line from now on.
Is a real accountant checking my books?
Yes. You get your own bookkeeper, Gus does the first pass on every transaction, and an accountant checks every one before your month closes. That same accountant prepares, signs, and files your business return. Goatkeeper is not a CPA firm, and we never pretend a person looked when they did not.
What does it cost, and can I cancel?
It starts at $197 a month, depending on what your business needs. No setup fee, no hourly bills, no contract. Cancel any time from the app, and your books go with you.
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What makes a bookkeeper worth paying for Every business we keep books for
Book a call
Pick a time. That's the whole signup.
Fifteen minutes with a real person on our team. They look at where your books are, tell you straight what it takes to get caught up, and get you set up on the spot if it fits.
- $197 a month to start
- An accountant on every transaction
- Cancel whenever